As antivaxxing continues to rear its ugly head, pediatricians are faced with some nasty decisions.

The vast majority of children in the developed world receive their vaccinations. Vaccines protect the children from nasty diseases such as measles or whooping cough, but in recent years, the trend of antivaxxing has managed to infect surprisingly many people. Although it is baseless and easily disprovable, antivaxxing has spread like wildlife, up to the point where the World Health Organization has listed it as one of the top 10 global health threats for 2019, alongside drug-resistant bacteria, HIV, and cancer.

With very few exceptions, all doctors recommend their patients to vaccinate their children. However, not all parents choose to follow the doctor’s recommendation. The other parents, those who do vaccinate their children, don’t think too lightly of this.

A survey carried on 2,032 parents of at least one child found that 4 in 10 parents are “somewhat likely” or “very likely” to move their children to a different provider if their doctor sees families who refuse all childhood vaccines. Furthermore, 3 in 10 parents believe doctors should ask parents who refuse all vaccines to find another health provider. For pediatricians, this isn’t an easy situation to manage.

“Pediatricians strive to keep children healthy through regular well-child care and this includes encouraging families to follow recommended vaccine schedules. When a family refuses all childhood vaccines, it puts providers in a challenging position,” says the poll’s co-director Sarah Clark, MPH.

“A completely unvaccinated child is unprotected against harmful and contagious diseases, such as measles, pertussis and chicken pox. Children who skip vaccines also pose a risk of transmitting diseases to other patients. This can be especially risky exposure for vulnerable populations, including infants too young to receive vaccines, elderly patients, patients with weakened immune systems or pregnant women.”

Although opinions were divided, a mere quarter of all parents believe doctors should see unvaccinated children without any restrictions.

Clark says it’s important for pediatricians to have multiple discussions with parents, explaining the importance of vaccinations and answering any unclarities about potential side effects. However, while situations in which parents still refuse vaccinations are rare, they do exist, and can pose significant threats for other yet-unvaccinated kids. For instance, the highly contagious measles virus can live for several hours in an area where an infected person coughed or sneezed, and can be spread even before symptoms appear.

“Primary care providers need to think carefully about whether to institute policies to prevent their patients from being exposed to vaccine-preventable diseases, and then communicate those policies to all patients in their practice,” Clark concludes.